COMMENTARY May 2019. Christian Journal for Global Health 6(1) A Biblical Reflection on the Passion of Jesus Christ as it Relates to 20 Years of Treatment-resistant Ministerial Depression Hunter Yorka a Cross-cultural Development Worker, Philippines. Abstract This is a reflective commentary on the article entitled, Understanding Refractory Depression: A Missionary’s Autobiographical Case Report. It is a focus on a spiritual therapy to minimize the debilitating symptoms of long-term refractory depression when other conventional and non-conventional treatments have been ineffective. Though not suggested as a cure, a focused faith on our identity with Christ and His with us can help us transcend some of the negative impacts refractory depression brings to the life of its sufferers. This is particularly relevant regarding Christ’s identification with our human sufferings. It can be categorized as a spiritual discipline where benefits improve as the sufferer becomes more adept at the practice. Key Words: Depression, Suffering, Jesus, Faith, Hope, Spiritual disciplines, Identification Introduction My previous article, Understanding Refractory Depression: A Missionary’s Autobiographical Case Report, was intended to show depression as a major global health problem and to reveal the inner life of a sufferer of treatment-resistant depression.1 There is a pain associated with depression that belies definition. The difficulty in articulating the condition makes it almost too abstract for our minds to effectively grasp and understand. Pain is, by its very nature, isolating, but the Scriptures can bring us out of isolation and into a new level of understanding and transcendence. Job is an entire book dedicated to examining one man’s journey through intense suffering and loss. In addition to insights on how Job was sustained by his faith, we also see how his pain was compounded by the inability of those closest to him to understand his suffering. Ultimately, after fulfilling their well-intentioned empathetic duties of comfort in their comparatively trouble-free lives, Job’s friends lost patience. The stubborn realities of Job’s problems did not resolve quickly and conveniently. We often see this same pattern of reaction by non-depressed people to the pain of depression sufferers today. Humans are impatient by nature, and this innate human quality led to what we often see today in the treatment of chronic illnesses without visible signs, especially when there is no response to therapies. When Job’s suffering took a lot longer than his friends thought necessary, they offered simplistic advice on how to expedite the fixing of his problem. Job was too honest to pretend the advice 52 York May 2019. Christian Journal for Global Health 6(1) was helping, and this presented a problem to onlookers. His wife and friends could not understand or identify with what he was going through and could not connect with him in a way that made sense to them. Their advice eventually devolved into judgement and disdain, and with their attitudes and words, they wrote him off as a hopeless case, guilty of pathetic unconfessed sin, self-pity and introspection. Proverbs 14:10 states, “Each heart knows its own bitterness, and no one else can share its joy” (NIV). Each of us, in our way, can identify with this. The Apostle Paul expands the concept of the exclusionary isolation of suffering in Philippians 3:10: “I want to know Christ, and the power of his resurrection, and the fellowship of sharing in his sufferings, becoming like him in his death, and so, somehow, to attain to the resurrection of the dead.” (NIV). Christians read this and easily identify with the sentiments of the first and second statements. But when we come to the “sharing of his sufferings,” we unconsciously backpedal and circumnavigate to the next verse. The reason Paul associates profound, experiential knowledge of Christ with suffering is because the nature of suffering is intimate. Nothing is more personal. When we are trouble free and prosperous, it is easy for people to want to be with us even if they are not emotionally close or committed to us. But when a person is in pain, when there is serious suffering, then there seems to be no upside to spending time with the sufferer. Only the closest, most committed friend can share those moments because only they have the capacity and willingness to share the burden of the pain even when sharing the pain does not solve the problem. This level of relationship identifies with another’s pain simply because love compels them. There does not need to be resolution for the connection to have meaning. I have been emotionally impaired for the better part of two decades. But, I refuse to surrender as long as God gives me faith. Faith is a gift that is essential to my survival. At times, I can barely conjure the will to go on and can only toss inarticulate, monosyllabic pleas out to God. “In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us through wordless groans” (Romans 8:26 [NIV]). Sometimes, there are desperate, simple words of supplication. Sometimes, there is only a silent pleading for comfort, but as long as I can turn my heart upward, there is hope. The proposed result of my autobiographical case report was to enable friends, family, and medical professionals to “see” more clearly into the pain of the depressed sufferer and, hence, be enabled to offer more effective therapy, counselling, connection, and comfort. In the end, there are no complete or definitive solutions to the intractable problem of treatment-resistant depression. Depression is a condition that sometimes can be cured, sometimes improved, and sometimes managed—but not always. Despite the severity of major depressive disorder (MDD) and the increase of the condition globally, medical professionals still have not come up with a standardized definition of treatment resistant depression (TRD) or a standardized procedure to determine if a person truly suffers from TRD. Workers in service occupations like medical professionals and the clergy are particularly prone to burnout and depression. It is generally agreed that healthy lifestyle improvements are important to supplement the treatment of depression sufferers.2 In long-term TRD cases, a study conducted by the Methodist Counseling and Consultation Services, North Carolina, suggested that a positive faith could help minimize the generalized negativity of chronic depression if the sufferer cognitively and consistently exercised it.3 This paper is insufficient to answer the question as to why so many depressed ministers permanently distance themselves from the ministry or have been led to missionary attrition. There is a biblical precedent, especially in the Psalms, for the experience of depression to be seen not as a weakness, but as an experience of the human condition and as an opportunity for enhancing 53 York May 2019. Christian Journal for Global Health 6(1) ministry effectiveness through trust in God as Healer and Redeemer. Some examples of these Psalms of lament are Chapters 3, 6, 13, 22, 28, 56, 102, and 142. These Psalms generally represent the writer in near impossible conditions, some kind of doubt or conflict, or deeply questioning about God’s purposes. Usually the Psalmist is able to talk through his problem with brutal honesty until he comes full circle to the character and faithfulness of God. Even in pain, sometimes caused by mistakes or sin, the Psalmist in these laments clings to the character of God instead of the weakness of himself and often appeals to be delivered from their extremities so that God will be glorified by showing his power, love, and faithfulness to those in covenant with him and to all the nations of the world (Ps. 22:27; 86:9, 102:15). In a modern context, some of these psalms can seem strangely self-serving, but the reality is that their faith in God’s promises to them ultimately overcame their doubts and fears. Verbalizing these desperate cries to God and others seems to be therapeutic and a witness to the grace of God. When Medicine Fails: Managing the Pain of Depression through Faith and our Identification with Christ We have the accounts of Job, David, Paul, and the list of saints and martyrs to visit the problem of personal pain. They are extremely helpful and encouraging in our confusing and bumpy pilgrimage of life. They are the top examples, but the supreme example of the emptying that comes with depression is Jesus. As Christians, we easily embrace His suffering for us and our identification with Him in our suffering. But have we contemplated the possibility that beyond understanding that Jesus suffered for us in the past, He also suffers with us today? Our identity in Him binds us to Him, and He will never leave us nor forsake us when we struggle with hard things (Heb. 13:5). When we are in the throes of debilitating anguish, we naturally feel isolated. It is not uncommon for us to feel that we are the only ones who have ever experienced our kind of suffering. Our prayers reach desperation, and our hearts cry out in confusion, “Where are you God?”, “Don’t you see my pain?”, “Why don’t you answer me?”, “Do you even care about me?” Honest prayer is the purest form of prayer. When we openly share our pain with God, we not only honor Him with our faith, we begin to walk the Calvary road with Jesus Himself. In the synoptic gospels, there is more identification of Jesus with our powerlessness and separation from God than there is even with important directives like the great commission to make disciples of the nations (Matt. 28:18). What is God trying to communicate to us through his incarnational suffering? Jesus not only suffered for us, He suffers with us. “If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it. Now you are the body of Christ, and each one of you is a part of it” (1 Cor. 12:26, 27 [NIV]). Walking the Path with Jesus through Depression In contemplating the final days of Jesus’ human life and work, we can see how He intimately identified with those who suffer from depression, and how He invites us to identify with Him. Jesus was sorrowful unto death. (Matthew 26:38, Mark 14:34) Faith is not a vaccination against despair. Elijah wanted to die, David was emotionally depressed often, Paul despaired of life, and Jesus, our Lord, who identified with the weakness of humanity, was sorrowful to the point of death. This kind of despair and sorrow is not viewed as weakness in the Scripture. These are honest expressions of the human condition in a fallen world where entropy reigns and relationships are broken. Jesus embraced both the good and the bad in the human experience. We can identify fully with Him only because He first 54 York May 2019. Christian Journal for Global Health 6(1) fully identified with us. Without the humanity of Christ, we could never have fully appreciated His deity. Jesus prayed for deliverance but God answered, “No”. (Matthew 26:39, 42; Mark 14:32; Luke 22:43) The “No” of God’s silence is something we have all experienced if we have ever pursued a regular prayer life. It is easy to understand when God seems not to get involved answering our prayers about an entrance exam, a job application, or a romantic interest. It becomes much more difficult to understand when God’s honor is at stake among people who have never heard of Him, when a young, promising missionary develops a chronic illness, or when a child suffers needlessly. These are life- threatening, eternity-threatening issues, and we are often confused by what appears to be indifference from God when we are in trouble. Regarding depression, I often think about the fruit of the Spirit which is supposed to characterize the authentic Christian experience. In the list found in Galatians chapter 5, the first three qualities cannot be conjured by faith, choice, or obedience. They are gifts from God: love, joy, peace. The following six qualities: patience, kindness, goodness, faithfulness, gentleness, and self-control, can be attained by making righteous choices. In my first fifteen years of ministry, I experienced near constant positive supporting emotions and a deep passion and love for my work. The past twenty years or so, this passion has been replaced by a commitment to finish well and hear the words, “Well done, good and faithful servant . . . come share in your master’s happiness!” (Matt. 25:21 [NIV]). In a sense, it is a case of delayed gratification. In Hebrews 11, especially verses 32-38, the list of spiritual heroes has two categories—those who were very successful and victorious, and those who suffered, lived, and died horribly. Yet, verses 39 and 40 state, “These were all commended for their faith, yet none of them received what had been promised, since God had planned something better for us so that only together with us would they be made perfect.” This is helpful because it reminds us that despite our experience in this world, pleasant or painful, our true hope is in eternity with God where, together, all the saints will receive the promise of God’s complete joy of our salvation (Ps. 51:12). But now, consider that the Son of God, the eternal Logos by whom the cosmos was created, calling out to His Father from the desperation of His humanity. Based on the results, it did not seem like the Father was moved to answer Jesus’ primary prayer for deliverance (Matt. 26:42). Did not Jesus say that if He wanted to, He could have called legions of angels to help Him? (Matt. 26:53) This seemingly impossible scenario of God not responding to the impending unjust death of His son has a deeper meaning than His plan of salvation for mankind and the redemption of all of creation. In this identification with our suffering, Jesus shares our pain of powerlessness, hopelessness, fear, a sense of complete separation from God, and possibly even doubt. Regardless of what depression may try to tell us, God is not aloof and indifferent. “The Lord is close to the brokenhearted and saves those who are crushed in spirit” (Ps. 34:18). Not only does He understand our pain, our lostness, our darkness, our sadness, and our confusion and bewilderment at conflict, He has experienced them himself as a man (Isaiah 53:5). He has entered the ultimate realm of intimacy with us. Because He has borne our pain, we have a confidant, a consoler, and a deep, faithful, and intimate friend. When we call out in our suffering to a God who we think is not listening, Jesus is with us sharing our pain. Jesus shares our pain not only through his infinite knowledge as God but with an understanding and empathy of personal human experience (Heb. 4:15). It was not only on the cross that He bore our pain and identified with our suffering and weakness. Jesus felt the pain of disconnection from God and all that is good: “My God, my God why 55 York May 2019. Christian Journal for Global Health 6(1) have you forsaken me?” (Matthew, 27:46, Mark 15:34) Depression destroys your connections. Association with all you value erodes, and a barren landscape of infinite hopelessness and distance emerges. Your positive feelings of connection with God and others dissolve, and you are left with a fading memory straining to recall what used to be. In the Lord of the Rings: The Return of the King trilogy movie, Frodo describes his diminished state to Samwise as “naked in the dark.” I can imagine that this is the greatest pain of hell, never being able to connect with anyone ever again. When we call out to God in this state and He does not answer, only faith can give us the hope on which we need to hang. Theologically, we can understand Christ’s separation from the Father as He bore our sin on the cross. On a personal level, it is profound to realize that before the actual atoning work of the cross, Jesus looked to God for help, but God did not seem to be there. Jesus’ identification with us was total. When he was afraid, vulnerable, and confused, He called out to his Father for help and was met with silence. This level of identification with us is almost incomprehensible. When God is silent in our pain, we need to remember that we are not alone. Jesus experienced this same kind of desperation for us. God had not abandoned Jesus, but in Jesus’ human emotions, it felt that way. It was for that moment Jesus’ human reality. God does not abandon us, but our feelings can make it feel that way. Jesus’ pain was misunderstood. “He is calling Elijah.” (Matthew 27: 47, 48; Mark 15:35, 36) When we think of poor comforters, it is natural to remember Job’s friends. Historical references aside, we usually do not need to look very far to see infinite variations of Job’s scenario. It is at great risk that the Christian honestly bares his heart and publicly shares his struggles with depression. Predictably, the initial response is some form of sympathy. Since true understanding of depression is impossible for anyone who has not personally experienced it, there is usually a difficulty to respond effectively. Pain is compounded when people misunderstand it. If someone today cried out in searing agony, “My God, why have you forsaken me,” he would almost certainly receive some kind of theological correction from well-intentioned Christians. This heart cry of Jesus was not about theology. It was about pain. Imagine how Jesus’ lowest moment got even lower when people misunderstood the sincerest expression of the most heart-felt feeling He had ever uttered. Jesus surrendered his spirit. (Matthew 27:50; Mark 15: 37; Luke 23:45) This is going to be the most controversial segment in this article. Anyone who has experienced chronic depression knows what it is like to run out of strength to fight on. Depression can be a war of attrition. It only takes. It never replenishes. When you lose the motivation or mental ability to continue to shore up the leaky dike of your will, you are in a very dangerous place. In the end, there often is no energy to want to keep going. You want to care, but you just cannot conjure enough energy to make it happen. Suicide is not only an attempt to stop the pain but a surrender to the seemingly inevitable disintegration of our humanity. This is the hardest concept for non-sufferers to understand. In this state, escape may seem like a pathway to a more peaceful existence. This is not a rational state for those in a truly depressive condition. Jesus was rational and in complete surrender to his Father’s will at the time He willfully surrendered his spirit and life. I mention His surrender to His inevitable death, not to debate that His work was or was not finished. He himself declared, “It is finished” (John 19:30). He had borne the sins of mankind and received the just wrath of God for our sake. I mention this because at this critical moment Jesus was also human. Simultaneously, He was the Son of God and the Son of Man. The torture definitely made him weak beyond description physically. But in addition to this, in His humanity, I believe He was completely 56 York May 2019. Christian Journal for Global Health 6(1) spent emotionally. With the understanding that He had completed his purpose, and there was no more reason to continue suffering, He committed his spirit to the Father (Luke 23:46). In the midst of depression, a person is not usually considering the pain that will be caused by his or her death. In the irrational state of impending suicide, the mind can twist all kinds of seemingly logical justifications for taking one’s own life. “I have already lived a full-life,” “No one really cares anyway,” “I can’t take this pain anymore,” and/or “What’s the point?” It does not matter what the justification is, it insidiously gives him or her an irrational justification to terminate the life God has given. This is a time when the disease has worn the sufferer down and figuratively has its foot on the throat. The sufferer may feel an inability to fight back and definitely a loss of desire to try. Many people who attempt suicide experience a return of energy to care, then call a friend or emergency services. Friends and family are baffled by this apparent contradiction. The common misunderstanding is that they were just looking for attention. It is critical here not to misunderstand that I am claiming Jesus was even remotely in the category of people I just described. Jesus was not looking for attention, and He certainly was not trying to commit suicide. But Jesus’ trauma had drained him, and the draining quality of trauma is something most of us experience at some point in our lives. He could have summoned the will to remain alive on the cross longer, but there was no point for that since He had already fulfilled the goal of His suffering as a substitutionary sacrifice for our sins. His death would complete that willing sacrifice. Unfortunately, many people who have been traumatized by abuse, tragedy, and depression can progressively slip into an emotional malaise that drains the energy to fight to stay alive. Jesus did not hasten death, He simply surrendered to the inevitable process of dying. “And when Jesus had cried out again in a loud voice, he gave up his spirit” (Matthew 27:50). Jesus was literally emptied for us (Phil. 2). He had every drop of life drained from Him. He understands emptiness. He has been there. The scripture and the creeds teach us that Jesus was fully God and fully man. This is a concept that is impossible to understand comprehensively. Because we acknowledge His deity, it seems disrespectful to believe that He shared all our weaknesses in human form. It is easy for us to accept that Jesus got hungry, needed sleep, or felt sadness, but his incarnation was far deeper than that. Jesus willingly submitted to all the weaknesses of the human condition. He experienced fear, despair, desperation, abandonment, and vulnerability, and He experienced it for us. He walked in our weakness for us, and He continues to walk with us in our weakness today. And He will walk with us until the day when pain and weakness will cease to exist and our redemption will be complete. For while we are in this tent, we groan and are burdened, because we do not wish to be unclothed but to be clothed instead with our heavenly dwelling, so that what is mortal may be swallowed up by life. Now the one who has fashioned us for this very purpose is God, who has given us the Spirit as a deposit, guaranteeing what is to come. Therefore, we are always confident and know that as long as we are at home in the body we are away from the Lord. For we live by faith, not by sight. (2 Cor. 5:4-7 [NIV]). As with all aspects of our relationship with Christ, while we still live in these fragile bodies and fractured communities, we live by faith. This is never truer than it is for a Christian with depression. Faith is even more essential when we have no sight at all. Paul tells us that for now we see as through a darkened glass. But for someone with depression, that darkened glass has been painted black and is in a dark room with no windows. Faith is what tethers us to a God we cannot see when all our senses tell us He is not there, or He does not care. God promises never to leave us or forsake us (Josh. 1:5). He is with 57 York May 2019. Christian Journal for Global Health 6(1) us in our sufferings, and He has a sympathy and a unique understanding, because for our sakes, He has known the frailty and pain associated with the human experience. He is omniscient and knows we are but dust (Ps. 103:4). He understands our weakness and does not condemn us for it. Developing a spiritual discipline that focuses on being present with Him and regularly affirming God’s stated favor for you will help when the self- loathing gets heavy, when the pulse begins to race and the urge to hyperventilate begins. I highly recommend Brother Lawrence’s The Practice of the Presence of God.4 Without faith, there is no hope, and without hope depression cannot be overcome. Faith is more than a claim to the promises of God. Faith is what allows us to cling to our Savior through the frequent and sometimes very long trials in life. Faith is what enables us to contemplate the suffering, incarnational Christ and His unwavering presence with us in our own sufferings during the times of despair when it feels like He has abandoned us. We share the Psalmist’s cry: “Restore to me the joy of your salvation and grant me a willing spirit, to sustain me” (Ps. 51:12 [NIV]). Conclusion In the end, there is much in life that we cannot control. Much of depression is related to our broken world and the demands we place upon ourselves or accept from others. When, by faith, we can learn to trust God to do what is ultimately best for us and His kingdom purposes when we are unable to control events that trouble us, we open ourselves up to a level of peace and trust based upon a rational acceptance of reality. This acceptance often does not remove the pain or cure the ill, but it redirects our focus from the hopelessness of things we have no power over to the One who loves us and has all power. This acceptance is a form of comforting surrender. During those moments when we can resign ourselves to desire nothing but the will of God, it does not matter if that will is pleasant or grievous because our delight is that it is the good, pleasing and acceptable will of God (Rom. 12:2). We are all a work in progress. It is especially difficult when a depressed person is besieged with doubt, guilt, and self-loathing. My personal journey with refractory depression has progressed from denial, to acceptance that it is only a phase that will pass, to dejection and discouragement, to confusion, some unhealthy self-medication, absolute despair, desperation, and, finally, to an acceptance and hope that I will someday see the goodness of the Lord in the land of the living (Ps. 27:13). The constant, cognitive practice of faith through spiritual disciplines that bring us into a better awareness of God is a lifelong journey but is essential to manage and transcend the trial of treatment resistant depression and learn to worship God with our imperfect lives. Isolation exacerbates depression, so I actively seek out Christian fellowship and counsel. Adele Ahlberg Calhoun’s Spiritual Disciplines Handbook: Practices that Transform Us5 is a helpful tool for a serious Christian’s personal journey to progress from the often-unhealthy control of our subconscious to developing a more conscious, controlled, and focused faith. Guided Christian mindfulness meditation sessions are exercises that I often find helpful in refocusing my overstressed mind on my Redeemer. Some of these are more guided prayers and some are deeper meditations.6 One of the names of Jesus is Emmanuel, which means, God with us. To the degree we are able to internalize this reality by faith, our hope in this life and for the next helps us transcend the unpleasant trials of chronic emotional pain and to remain effective instruments of God’s mission. References 1. York H. Understanding treatment-resistant depression: a missionary’s autobiographical case report. Christ J Global Health. May 2019;6(1):43-50. https://doi.org/10.15566/cjgh.v6i1.275. https://doi.org/10.15566/cjgh.v6i1.275 58 York May 2019. Christian Journal for Global Health 6(1) 2. Berk M, Sarris J, Coulson CE, Jacka FN. Lifestyle management of unipolar depression. Acta Psychiatr Scand Suppl. 2013;(443):38-54. 3. Golden J, Piedmont RL, Ciarrocci JW, Rodgerson T. Spirituality and burn out: an incremental validity study. J Psychol Theol. 1 June 2004;32(2):115-25. https://doi.org/10.1177/009164710403200204 4. Brother Lawrence. The practice of the presence of God. London: Epworth Press. Available from: https://www.basilica.ca/documents/2016/10/Brother% 20Lawrence- The%20Practice%20of%20the%20Presence%20of%2 0God.pdf 5. Calhoun AA. Spiritual disciplines handbook: practices that transform us. Downers Grove, IL: IVP Books. 2005. 6. Spiritual exercises for mindfulness meditation examples [Internet]. Be at peace: feeling God's presence through guided Christian meditation and prayer. Available from: https://www.youtube.com/watch?v=qtcg7bKEVew&t =3s. Christian mindfulness loving embrace meditation. Available from: https://www.youtube.com/watch?v=SwzqwhXhL6A& t=18s. Mindfulness meditation: Being still in the presence of God Available from: https://www.youtube.com/watch?v=826gdM79UzA. Peer Reviewed: Submitted 29 Jan 2019, accepted 13 April 2019, published 31 May 2019 Competing Interests: None declared. Correspondence: Hunter York, Philippines. hunteryork68@yahoo.com. Note that for reasons of patient privacy and security, a pseudonym was used for the author. Cite this article as: York H. A biblical reflection on the passion of Jesus Christ as it relates to 20 years of treatment-resistant ministerial depression. Christ J Global Health. May 2019; 6(1):51-58. https://doi.org/10.15566/cjgh.v6i1.279 © Author. 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